Purpose : Polygonum cuspidatum extract is an oriental herb which has been used for uterine diseases. In this study, the effects of Polygonum cuspidatum extract were investigated on inducing growth inhibition and apoptosis of human uterine cervical carcinoma cells. Methods : Viability of Polygonum cuspidatum extract-induced ME-180 cells was measured by MTT assay. Apoptotic cells were visualized by EtBr/AcOr staining under fluorescent microscope. Nucleosomal DNA fragmentation was assayed by agarose gel electrophoresis. Cell cycle distribution and changes in mitochondrial membrane potential were observed by flow cytometry. Results : Polygonum cuspidatum extract induced ME-180 cell death in a dose- and time-dependent manner. In the cells treated with Pc, the population of cells at sub-G1 phase significantly increased, and the condensed nuclei, apoptotic bodies and nucleosome-sized DNA were detected. Moreover, reduction in mitochondrial membrane potential was detected. Conclusion : Polygonum cuspidatum extract inhibits the growth and proliferation of ME-180 cells by apoptotic induction and facilitates its activity initiated by depolarization of mitochondria.

Purpose : This study was conducted to investigate the inhibitory effects of Cortex ulmi pumilae on cell proliferation in HeLa cell. Methods : Human uterine cervical carcinoma HeLa cells were cultured in the 1%, 5% and 10% concentration of Cortex ulmi pumilae solution for 24 hours, 48 hours and 72 hours for the direct inhibitory effects of Cortex ulmi pumilae. Afterwards, we executed the analysis of the effect of Cortex ulmi pumilae solution on cell proliferation inhibition using XTT assay, DNA fragmentation, molecular biological method through MAP kinase activity and FACS analysis of caspase activity in the HeLa cells. Results : After 48 and 72 hours cultivation, the HeLa cells showed the concentration-dependently significant increase in all Cortex ulmi pumilae solution containing groups compared to the control. In the FACS analysis, all Cortex ulmi pumilae solution containing groups showed concentration-dependent increase compared to the control after 24 hours cultivation and the caspase-3 activities were decreased in all Cortex ulmi pumilae solution containing groups compared to the control after 24, 48 and 72 hours cultivation. After 48 and 72 hours cultivation, we could examined the apparent DNA fragmentation in all Cortex ulmi pumilae solution containing groups. In the XTT study, all Cortex ulmi pumilae solution containing groups showed concentration-dependent decrease compared to the control after 24 and 72 hours cultivation but 10% group after 48 hours and 5% and 10% groups after 72hours were presumed statistically significant differences. The expressions of MAP kinase were decreased in all Cortex ulmi pumilae solution containing groups compared to the control after 24, 48 and 72 hours cultivation. Conclusion : From this study we could suggest that Cortex ulmi pumilae be available to the inhibition of apoptosis of human cervical carcinoma cell line in vitro.

Purpose : The Purpose of this research was to investigate the effects of antithromb otic activities of Honghwadangguisan(HDS) Methods : Measured the effect which was given to blood flow rate through the regular volume of glass tube after the blood was diluted five times with ACD soulution. Antithrombotic effect was calculated as a percentage of the experimental animal figure protected from the paralysis of hind legs or death of the mouse that is caused from the administration of platelet aggregation regent. Each of the groups consisted in 8 mice, was divided into Normal, Control, and HBS. All of these 3 group were supplied a saline solution and after an hour the control group brought the dextran extravasated blood. Also the HDS group was dosed to the experimental mice with Oral Zonde one day before the experiment. After that, the mice were abstained from food. And then we gave a measured amount of it before an hour. Finally, it gave rise to dextran extravasated blood as well as the Control group. Results : The results were obtained as follows. In vitro, HDS inhibited platelet aggregation induced by ADP and epinephrine significantly as compared with the control group. HDS showed fibrinolytic activity insignificantly as compared with the control group. HDS reduced blood flow rate in significantly as compared with the control group. In vivo HDS inhibited pulmonary embolism induced by collagen and epinephrine (inhibitive rate 50%). HDS increased number of platelet, fibrinogen amount and shortened prothrombin time, activated partial thromboplastin time significantly but reduced blood flow rate insignificantly as compared with the control group in thrombus model induced by dextran. Conclusion : HDS is effective antithrombotic activity from experimental result.

Purpose : This study was carried out to investigate the effects of Gagamdokhwalgisang-Tang on the morphometric changes of femur, and on the hormones and cytokines associated with bone metabolism in overiectomized rats. Methods : Twenty-four female Sprague-Dawley rats were divided into sham operated group(normal) ovariectomized group(control), and treated with extract of GD group(treated). Each group was evaluated the changes of body weight at 0, 3, 6, 8 weeks after ovariectomy. Morphometric analysis(femur weight, femur/body weight ratio, femur ash weight femur ash/body weight ratio cross sectional area of compact bone and concellous bone of femur) and histopathological examination were performed at 8 weeks after ovariectomy. Estrogen, Alkaline Phosphatase(ALP) and cytokine(Tumor necrosis , , Inerleukin-6) assay were performed at 8 weeks after ovariectomy. Results : 1. The body weight of control and treated group was significantly increased(p<<0.001) compared with the normal group at 8 weeks. 2. The femur weight and femur/body weight ratio of treated group were significantly increased(p<<0.05, p<<0.01) compared with the control group at 8 weeks. 3. The femur ash weight showed no significantly different changes, but femur ash/body weight ratio of treated group was significantly increased(p<<0.05) compared with the control group at 8 weeks. 4. In the cross sectional area of cancellous bone of femoral body, the treated group was significantly increased(p<<0.001) compared with the control group at 8 weeks. 5. The serum estrogen level of treated group showed no significantly different changes compared with the control group at 8 weeks. 6. The serum ALP activity of treated group was significantly decreased(p<<0.01) compared with the control group at 8 weeks. 7. The serum Tumor necrosis level of treated group was significantly decreased(p<<0.05) compared with the control group at 8 weeks. 8. The serum level of treated group was significantly decreased(n<<0.001) compared with the control group at 8 weeks. 9. The serum Interleukin-6(IL-6) level of treated group was significantly decreased(P<<0.01)compared with the control group at 8 weeks. Conclusion : These results indicate that GD inhibits bone resorption in ovariectomized rats. And the major inhibitory mechanism may be related to the inhibitory effects of GD on the secretion of , and IL-6 in the pathogenesis of osteoporosis in estrogen deficient rats.

Purpose : This study is to evaluate the synergistic cytotoxicity of Rhizoma Rehmanniae(RR), in adriamycin-treated HeLa human cervical carcinoma cells. Methods : We culture HeLa cell which is human metrocarcinoma cell in D-MEM included 10% fetal bovine serum(Hyclone Laboratories) below , 5% . Then we observed apoptosis of log phage cell which is changed cultivation liquid 24 Hours periodically. Results : The combination of RR and adriamycin synergistically augmented the cytotoxicity of HeLa cells. The apoptotic cell death was accompanied by the activation of caspase-3 and -8 as well as cleavage of poly(ADP- ribose) polymerase (PARP) in HeLa cells. The co-treatment of RR with adriamycin didn't have any effect on either the expression of Bcl-2 or that of Bax. Interestingly, a synergistic increase in apoptosis by the combination of two drugs was accompanied by the enhancement of Pas and Fas ligand (FasL) expression in HeLa cells. Taken together, the combination of RR and adriamycin significantly augmented the apoptotic cytotoxicity of Fas-positive cells, such as HeLa cells. The pathway is not involved in mitochondria-dependent pathway. Conclusion : RR induces apoptosis in HeLa cells via p38 MAPK activation.

Purpose : this study is to examine what are the effects of the Sintongchukeatang(SCT) on the ovariectomized rat model of postmenopausal osteoporosis. Methods : 12weeks Female Sprague-Dawley 30 rats of weighting 250-300g, were divided into three groups including the sham operation groups(10heads) and overiectomy groups(10heads). then we observed changes in the body weight serum metabolic products and femoral trabecular bone. Results : 1. The level of serum ALP activity in control group showed significant increase in comparison with sham, but that in SCT-treated was significantly decreased in comparison with control. 2. The level of serum GOT in control group showed no change in comparison with sham, but that in SCT-treated was significantly decreased in comparison with control. The level of serum GPT did not significant change among the three groups. 3. The level of serum estrogen in control group showed slightly decreased in comparison with sham, but that in SCT-treated showed no change in comparison with control. 4. Trabecular bone area as well as trabecular thickness in control group showed significant decrease in comparison with sham. Those in SCT-treated showed significant increase in comparison with control. 5. Trabecular separation only in SCT-treated showed significant decrease in comparison with control. 6. Osteoclast number and oseoblast surface in control group showed significant increase in comparison with sham. Those in SCT-treated showed significant decrease in comparison with control. Conclusion : SCT has shown to be capable of preventing and curing osteoporosis caused by old-aged and postmenopause.

Purpose : To address the ability of Myrrha (MY) to induce cell death, we investigated the effect of MY on apoptosis. In human cervical carcinoma HeLa cells, apoptosis occurred following MY exposure in a dose-dependent manner. Methods : We have tested several kinds of anti-oxidants to investigate the MY-induced apoptotic mechanism. Among the anti-oxidants, N-acetyl cysteine(NAC) or reduced glutathione (GSH) protects MY-induced apoptosis. NAC is an aminothiol and synthetic precursor of intracellular cysteine and GSH. To confirm the role of GSH in MY-induced apoptosis, methionine and cystathionine-glutathione extrusion inhibitors were treated in the presence of MY. Results : NAC, GSH, methionine or cystathionine led to protective effect against MY-induced apoptosis in HeLa cells. The GSH and GSH-associated reagents regulate MY-induced cytochrome c release and the resultant caspase-3 activation. Furthermore, the two specific inhibitors of carrier-mediated GSH extrusion, methionine and cystathionine demonstrate GSH extrusion occurs via a specific mechanism. While decreasing GSH extrusion and protecting against MY-induced apoptosis, methionine and cystathionine failed to exert anti-apoptotic activity in cells previously deprived of GSH. Conclusion : the target of the protection is indeed GSH extrusion. This shows that the protective effect is achieved by forcing GSH to stay within the cells during apoptogenic treatment. All this evidence indicates the extrusion of GSH precedes andis responsible for the apoptosis, probably by altering the intracellular redox state, thus giving a rationale for the development of redox-dependent apoptosis in MY-treated human cervical carcinoma HeLa cells.

Purpose : This study was conducted to investigate the dose dependent effects of Panax Ginseng on the reproductive functions in mice. Methods : We used the 8-week-old mice, and administered 0.2ml extract solution of Panax Ginseng in the different concentration once a day for 60 days. The control group was administered 0.2ml normal saline in the same way and duration. We counted the total, motile and normal sperm number of the cauda epididymis and measured the activities of sperm hyaluronidase, peroxidase and catalase of the isolated testis tissues. And we observed histological changes of surgically isolated testis by histochemical methods. Results : All Panax Ginseng extract solution groups showed significantly dose dependent differences in the total number, the motility and normality of sperms compared with the control group, respectively. In the histological analysis of the testicular tissues, all Panax Ginseng extract solution groups showed the enlargement of testicular lobe diameter and apparent angiogenesis between seminiferous tubules. And the activity of typical sperm enzyme, hyaluronidase, was significantly increased in the Panax Ginseng extract solution groups compared to the control group. In the antioxidant activity analysis, the activities of peroxidase and catalase were significantly increased in the Panax Ginseng extract solution groups compared to the control group. Conclusion : This study shows that Panax Giseng has the beneficial effects on the concentration, morphology and motility of sperm, the activities of sperm hyaluronidase, testicular peroxidase and catalase. We can suggest that Panax Ginseng be useful for the treatment of male infertility.

Purpose : This study was to investigate the effects of Dohongsamul-tang extract on the rat with an surgically induced endometriosis. Methods : Four weeks after the operation for inducing the endometriosis to a matured female rat, the normal hyperplasia of the transplanted endometrium was identified in anatomico-histological aspects. By dividing each of the control group and Dohongsamul-tang administered experimental group into 8 rats, Dohongsamul-tang concentrates were administered orally to the experimental group with 1g/1ml/200g everyday for 40 days and then images were taken from the macroscopic tissues which were transplanted to the mesenterium, and the concentrations of progesterone, estradiol, tumor necrosis , and interleukin(IL)(-2, -4, -6, and -10) in the serum were measured. Results : Transplanted endometrium tissues showed the histological findings in accordance with the normal endometrium tissues and from the macroscopic findings the size of transplanted endometrium tissues showed a definite decrease. Compared to the control group, the experimental group showed significant decreases in the values of ,IL-2, and IL-4 and significant increases in the values of IL-10. However, there were no significant differences in progesterone, estradiol and IL-6. Conclusion : From the above results, Dohongsamul-tang showed the strengthening of immunological function and anti-inflammatory effect. Therefore it is considered that Dohongsamul-tang will be very effective on the treatment of inflammation developed endometriosis, especially to treat the endometriosis without affecting the ovary functions.

Objective : This experimental study was carried out to investigate anti-coagulation effects and mechanism of Hongdeung-tang on the dissentimenated intravascular coagulation Methods : Each 10 rats were classified as normal gorup, control group and treated group. The control group was given a 0.5mg/ml endotoxin intra-vein injection and was occurred Disseminated Intravascular Coagulation(DIC). The treated group were orally administrated 1ml Hongdeung-tang concentration once a day for 6 days and then it was treated the same as the control group. We took the blood from heart and were investigated number of Platelet and white blood cell(WBC), fibrinogen concentration, prothrombin time(PT), activated partial thromboplastin time(APTT), interleukin-6(IL-6), Tumor Necrosis , Prostaglandin from them. Results : There were a statistically significant increase of platelet and fibrinogen concentration in the treated group compared to the treated group. The PT was a significantly reduced in treated group compared to the control group. There was no significant change in numbers of WBC and APTT between control and treated group. On the contrary, the number of PT, IL-6, , were significantly decreased in treated group compared to the control group. Conclusion : DIC which was occurred by endotoxin intravenous injection seems to related to the increase of IL-6, , and Hongdeung-tang has an effect that supress those factors. we can assume Hongdeung-tang has an anti-coagulation effect by those supressing effect.

Purpose : This investigation was undertaken to evaluate the antiproliferation, atoptosis of Sam-nueng(Sparganii Rhizoma) extract using MCF-7 human breast cancer cells. Methods : MCF-7 cells were cultured in Dulbecco's modified Eagle's medium/F12(DMEM/F12) supplemented with 10 % fetal bovine serum(FBS; Gibco) and antibiotics. At varying times after extract treatment, cells were harvested with scraper and processed for analysis of protein expression, proliferation, cytotoxicity and apoptosis. Results : Our results show that the extract of Sam-nueng(Sparganii Rhizoma) strongly inhibits the proliferation of MCF-7 cells in a dose and time-dependent manner. Sulforhodamine B showed that the addition of Sam-nueng(Sparganii Rhizoma) extract reduced the viability of MCF-7 cells in a dose-dependent manner. Poly[ADP(ribose)] polymerase(PARP) which serves as a marker of cells undergoing apoptosis, a major substrate for caspase-3 was extensively cleaved in the Sam-nueng(Sparganii Rhizoma)-treated cells. Conclusion : So, we can conclude that Sam-nueng(Sparganii Rhizoma) can have an inhibitive effect on MCF-7 human breast cancer cells by variable mechanisms.

Purpose : The aim of this study was to investigate objective evaluation of dysmenorrhea. Methods : The study was conducted by 37 articles from year 1979 to 2003 on dysmenorrhea, scale and questionaire. The articles was limited by English, Human, and Clinical trial Results : 1. The 37 articles on dysmenorrhea evaluated by scale or questionaire have been published from 1979. There are 27 articles of randomized controlled trial among them. 2. Scale or question has confidence in the assessment of dysmenorrhea. 3. In the initial stage the article on dysmenorrhea was assessed by only one unidimentional scale. However in recent articles multidimensional scales are applied frequently. Moreover it is the modern trend that point scale such as 100mm VAS and MVRS(multidimensional verbal rating scale) are applied together in one article on dysmenorrhea. Conclusion : It can be suggested that scale or questionaire be the method for objective evaluation of dysmenorrhea.

Purpose : This study was conducted to investigate the effect of pregnancy and parity on bone marrow density using Dual Energy X-ray Absorptiometry (DXA) after parturition Methods : The observation cases who was over 20 and under 35 years old just after childbirth were admitted twice to woosuk university hospital from Aug 2000 to July 2005. During the first admission period, we measured the bone marrow density(BMD) using DXA in 13th day, and when the patient came to the hospital just after childbirth again, we followed up the BMD in 13th day. The evaluation index of this report was comparison of the T-score which was about the lumbar spine(L1-L4) BMD and femur neck BMD. Results : The continuous parturition was increased the lumbar spine BMD(P<<0.05), and decreased the femur neck BMD but it had no meaning. In the cases of the parturition interval under 24 months regarded as siblings born within a year of each other, the analysis results of BMD showed increase in lumbar spine BMD. In the cases of the parturition interval over 24 months, there was increased in lumbar BMD, and decreased in femur neck BMD. To the analysis of the weight variation, the increased BMI group has a significant increase in lumbar spine BMD, and the decreased BMI group also increase in lumbar spine BMD but there was no meaning about that. Conclusion : The continuous parturition was increased the lumbar spine BMD.

Purpose : Because girls at puberty· are lack in sex ability, temporary menstruation disorder can be occured. This disorder is considered that will be disappeared as growing, so people used to leave the disease untreated and just watched. But clinically I frequently experience not to disappear. So I have carried out this study to investigate the actual condition of young girls's menstrual disorders. Methods : I researched 440 high school girls in Pusan by Menstruation Diary which I made about menstrual cycle, duration, amount and pain. The results were managed by the ststistics. Results :1. Menstrual cycle 1) In disorder of menstrual cycle, persons who have Bate menstruation are more than persons who have premature menstruation. 2) Persons who have normal menstrual cycle are in 124 persons(28.51%), the others who have severe premature menstruation or late menstruation more than one time for 4-7 months are in 311 Persons.(71.49%) 2. Menstrual duration and amount 1) Persons who have normal menstrual amount we in 66-89%, hypermenorrhea is in 1-11%, hypomenorrhea is in 5-21%. 2) In the study of menstrual duration, persons more than one thirds are irregular in thier menstrual amount every menstruation. 3) In the study of MMQ, persons who are irregular in thier menstrual amount every menstruation are in 125persons.(29.76%) 3. Menstrual pain 1) Persons who have slight menstrual pain are in 289 persons(65.98%), the middle is in 86 persons(19.63%) the severe is in 34 persons(7.76%) by MMP. 2) Persons who are irregular in thier menstrual pain every menstruation are in 145 persons.(33.11%) Conclusion : In menstrual cycle, there are more persons who have irregular menstrual cycle than normal.(71.49%) In menstrual duration and amount, more persons have normal menstrual amount.(66-89%) In menstrual pain, persons who have slight menstrual pain are the most.(65.98%)

Purpose : To investigate the medical information related to HRT online and the medical treatment of perimenopausal and postmenopausal women in the Dept. of Ob&Gy Korean Medicine Hospital, after the discontinuance of the WHI trial in U.S, July 2002. Methods : With the key-words "HRT", "Hormone Replacement therapy", "호르몬 대체요법(HRT)", 갱년기 증후군(perimenopausal syndrome)", “폐경기후증후군(postmenopausal syndrome)", I searched for the information from July 2002 to 2005 on DAUM, the representative portal site in Korea, and I've got a grasp of the tendency of the informational propagation on HRT. Moreover, I investigated chief complaints and tendency of give up HRT of the perimenopausal and postmenopausal women(aged between 47 and 60) who visited Dept. of Ob&Gy Korean Medicine Hospital for 2 years and 6 months since July 2002. Results : 1) Searching for the news on DAUM, I found; 2 articles on the methods of HRT: 4 on the positive effects of HRT: 4 on the general items including the positive effects of HRT: 19 on the side effects of HRT: 1 on the insignificant effect of HRT :4 on the apprehensions about HRT: 3 on the strengthening of the criteria on medical fees review: 3 on the discontinuance of HRT: 8 on the alternative materials and medicines to HRT: 4 on the guidance for the phyto-estrogen. 2) I analyzed chief complaints of 120 women. The majority of chief complaints were vasomotor symptoms like hot flush and sweating. There were only 4 patients who wanted to give up HRT. Conclusion : The side effects of HRT were objectively dealt with online but there was not enough effective and continuous guidance. In the case that a woman not on HRT wishes to overcome perimenopausal period through KM therapy, this information may have affected her decision. However, not many women who were already on HRT terminated the therapy for fear of side effects and switched to KM therapy. Promotion of KM therapy in improving health during perimenopausal and postmenopausal period is desperately needed.

Purpose : A study on the recognition about osteoporosis and TKM treatment for osteoporosis of women who visited Sangji Oriental Medical Hospital. Methods : We studied the recognition and realities of TKM treatment for osteoporosis with questionnaire from 14th september, 2005 to 14th October, 2005 in Sang-ji Oriental medical clinic. A questionnaire was given to 184 women and 171 women answered. Results : 1) In 171 women, 169(98.8%) women have heard about osteoporosis, 1(0.6%) woman hasn't heard about it, and 1(0.6%) woman doesn't know. 2) In 171 women, 85(49.7%) women checked up for osteoporosis. 31(36.1%) women of them were diagonosed as osteoporosis, 50(58.1%) women of them were not diagonosed as osteoporosis, and 5(5.8%) women of them didn't know.3) In 31 women, 18 women is taking none medical care, 5 women calcium supplement, 4 women HRT, and 4 women both therapy. 4) In 171 women, 74(43.3%) women know about TKM treatment for osteoporosis, 96(56.1%) women don't know. 5) In 171 women, 140(81.9%) women have intention of TKM treatment for osteoporosis, 17(9.9%) women don't have, and 14(8.2%) women don't know. Conclusion : The guide that treats osteoporosis with T]U is needed on purpose to make intention of TKM treatment for osteoporosis to real demand. If the guide be informed to oriental doctors, It can expand the range of oriental gynecology.

Purpose : To assess the duration of the therapeutic effect and recurrence symptoms after stopping Herb Medication therapy for climacteric womens. Methods : 28 climacteric womens received only Daejo-hwan(DJH): 2pills(4g) a time, three times a day for a total 8 weeks as maintenance therapy and were followed up for 3 months. Grading of climacteric symptoms were measured by Kupperman's index(K.I.), Greene scale(G.S.) and MRS. Results : The results were as follows. 1. After DJH-treatment, the climacteric symptoms were improved and each mean score of K.I., G.S., and MRS reduced significantly. 2. At 3 months after the end of treatment(EOT), each mean score of K.1., G.S., and MRS reduced significantly as compared with Baseline, and increased significantly as compared with EOT. 3. At 3 months after EOT, each climacteric symptoms kept up the favorable turn and the mean score of MRS reduced significantly as compared with Baseline, but made no significant difference as compared with EOT. Conclusion : In this study, we can consider the DJH-treatment therapeutic effect was kept up for 3 months after EOT and recurrence symptoms did not appeared after EOT to climacteric womens.

Purpose : Dysmenorrhea which repeat every menstrual phase give complaints like pain, vomiting, nasal bleeding and etc. But in many textbooks pathogenesis and treatment process of dysmenorrhea obscure. So the purpose of this study is to identify the conception, pathogenesis and treatment process of dysmenorrhea. Methods : After catching the limitations of preexistence theory about dysmenorrhea, I show a meaningful argument of dysmenorrhea. Results : The conception, pathogenesis and treatment process of dysmenorrhea are like this. Dysmenorrhea which occurs for menstrual phase can make deficiency of blood. There are intimate relations between uterine function and the five Zang-organs, especially heart, spleen and liver, so menstruation induces the weakness of those organs. And the insufficiency of kidney and conception-thorough vessel which have control over the uterine function can make dysmenorrhea. Conclusion : The deficiency of kidney which is responsible for holding Qi breaks down the balance of Zang-organs Yin-Yang, then dysmenorrhea appears through Zang-organs weakness of heart, spleen and liver. For the treatment of dysmenorrhea, we should consider preferentially the deficiency of kidney, afterward Bianzheng Lunzhi of the Zang-fu organs.

Purpose : To report the clinical condition and the effect of oriental medicine treatment on patients with uterine myoma. Methods : Our research was based on 41 cases of uterine myoma through medical records from November, 2003 to March, 2005. Research items were age of patients at first visit, BMI, past medical history, pregnancy history, preceding operation, constitution, accompanied symptoms, results after Oriental medicine treatment, treatment period. And we analyzed statistically about factors to affect results after treatment. Results : Average age of patients was 34.8 years old. After Oriental medicine treatment, the size of myoma of 9 patients(47.4%) lessened or disappeared, the VAS pain score during periods was decreased in 17 patients(72.7%). Conclusion : The result showed that Oriental medicine treatment can be effective for the management of uterine myoma without hysterectomy.